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INDIAN RIVER STATE COLLEGE
FACILITIES & SUSTAINABILITY DEPARTMENT
ENGINEERING & BUILDING ADMINISTRATION DIVISION
3209 VIRGINIA AVENUE
FORT PIERCE, FLORIDA 34981
Phone (772) 462-7750
Fax (772) 462-4687
APPLICATION
MAJOR PROJECTS
GENERAL INFORMATION
(TO BE SUBMITTED BY THE PROJECT CONTRACTOR OR CONSTRUCTION MANAGER)
APPLICANT
LAST NAME: FIRST NAME:
STREET ADDRESS: DATE:
CITY: STATE: ZIP:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
CONTRACTOR TYPE & LICENSE NUMBER:
QUALIFYING AGENT’S NAME:
QUALIFYING AGENT’S SIGNATURE:
PROJECT NAME: BCA NUMBER:
STREET ADDRESS:
$ VALUE & DESCRIPTION OF WORK:
Occupancy
Classification
Construction Type
(FBC)
Floor Area
Gross Square Feet
Building
Height
(Feet)
click to sign
signature
click to edit
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INDIAN RIVER STATE COLLEGE
FACILITIES & SUSTAINABILITY DEPARTMENT
ENGINEERING & BUILDING ADMINISTRATION DIVISION
BUILDING PERMIT APPLICATION
ARCHITECT/ENGINEER LIST
ARCHITECT
LAST NAME: FIRST NAME:
STREET ADDRESS:
CITY: STATE: ZIP:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
CIVIL ENGINEER
LAST NAME: FIRST NAME:
STREET ADDRESS:
CITY: STATE: ZIP:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
MECHANICAL ENGINEER
LAST NAME: FIRST NAME:
STREET ADDRESS:
CITY: STATE: ZIP:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
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INDIAN RIVER STATE COLLEGE
FACILITIES & SUSTAINABILITY DEPARTMENT
ENGINEERING & BUILDING ADMINISTRATION DIVISION
BUILDING PERMIT APPLICATION
SUB CONTRACTOR LIST
ELECTRICAL SUBCONTRACTOR
LAST NAME: FIRST NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
MECHANICAL SUB CONTRACTOR
LAST NAME: FIRST NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
PLUMBING SUB CONTRACTOR
LAST NAME: FIRST NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
ROOFING SUBCONTRACTOR
LAST NAME: FIRST NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
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INDIAN RIVER STATE COLLEGE
FACILITIES & SUSTAINABILITY DEPARTMENT
ENGINEERING & BUILDING ADMINISTRATION DIVISION
BUILDING PERMIT APPLICATION
SUBCONTRACTOR LIST
(CONTINUED)
GAS SUBCONTRACTOR
LAST NAME: FIRST NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
OTHER SUB CONTRACTOR
LAST NAME: FIRST NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
OTHER SUB CONTRACTOR
LAST NAME: FIRST NAME:
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
LICENSE NUMBER:
GENERAL / BUILDING CONTRACTOR’S SIGNATURE:
DATE:
click to sign
signature
click to edit